Immune Thrombocytopenia in Low- and Middle-Income Countries: A Systematic Review

BackgroundImmune thrombocytopenia (ITP) is an acquired immune-mediated platelet disorder. Most evidence informing its diagnosis and management comes from high-income settings as transferability to low- and middle-income countries (LMIC) may not be possible. We conducted a systematic review to characterise adult ITP in this setting.MethodsWe conducted this systematic review in accordance with PRISMA guidance. Studies reporting adult ITP in LMICs were included if they provided data on epidemiology, infections, first- or second-line treatment, or patient-reported outcomes.ResultsTwenty studies were included in this review. ITP often presented in younger adults than typically reported in high-income settings. Secondary ITP accounted for a substantial proportion of cases. Infectious associations, particularly Helicobacter pylori, hepatitis C virus, and HIV, were important contributors to this. Corticosteroids remained the common first-line therapy but was used for prolonged periods. Limited access to newer agents meant that second-line management frequently relied on azathioprine, dapsone, anti-D or splenectomy. Patient-reported outcome data suggested substantial effects on daily activities, work, emotional wellbeing and treatment burden. Most studies, however, were single-centre observational reports and were judged to be at moderate risk of bias.ConclusionITP in LMICs is shaped by distinct factors. Resource-specific diagnostic and treatment frameworks are needed.